FORM RE-13

Pass for Use of Explosives

Pass issued by the Licensee to Transport Explosives for Use
(Explosives other than Detonators)

Part - A
1. Pass No. : RE-13/2016/4075465

Date : 11/07/2016 Time : 5:20 PM

Connected Pass No. : RE-13/2016/4075512

2. This pass covers 2 packages containing following explosives :
Brand Name
(Brand ID)

S. No.

Class Div. Grams Quantity Unit

Nos. of
Batch Nos.
Package

Batch Date

Nos. of
Cartridge
100

Powergel Boost (Cap/Cord Sensitive) (738)

250g

25.000 Kg.

424837033

15/06/2016

Powergel Boost (Cap/Cord Sensitive) (738)

250g

25.000 Kg.

424837041

16/06/2016

50.000 Kg.

Sub Total (738)

100
200

while transit from Use magazine covered under Licence No. : E/HQ/JH/22/328(E51574), in Form : LE-3 (Old Form 22) , situated at : Plot No. : (Magazine
No.1) Plot No. 372, Survey No. 48, Village Town Name : Village Barughutu, P.O. Ghatotand, District : RAMGARH, State : Jharkhand to Place of Use "covered
under Mines Act, 1952" at : Topo Sheet No. : 73 E/9, Village Town Name : PARSABERA, Police Station : GHATOTAND OP, District : RAMGARH, State :
Jharkhand

3. The explosives are being transported by road van number JH-02/B-6397 having licence number E/EC/JH/25/361(E51162) till 31/03/2019.
4. Name of Agent of Mine /Owner/Authorised Person of Site of Use

NARENDRA KUMAR GUPTA

QUARRY SEB PO GHATOTAND PIN 825314
District : RAMGARH, State : Jharkhand

5. Full Address of Site of Use

Topo Sheet No. : 73 E/9

Village Town Name : PARSABERA, Police Station : GHATOTAND OP
District : RAMGARH, State : Jharkhand

6. No. of Holes to be Fired

200

7. Purpose of Use

Mining

8. Approximate Distance between Magazine and Site of Use

6 KM

Signature
Signature
Blaster Name : ASHIM KUMAR ROY
DGMS Certificate No.: 9841(3720)

Signature
Name of the Agent of Mine/Owner/
Authorised Person of Place of Use NARENDRA

Shri Barun Banerjee (Authorized Signatory)

For M/s. Tata Steel Limited (West Bokaro Division)

(Licensee)
Licence Number

KUMAR GUPTA

E/HQ/JH/22/328(E51574)

Licence Form
LE-3 (Old Form 22)

Important Notes :
1. The quantity of Explosives issued should be the quantity likely to be used during the day.
2. The Place of use may be at a distance from magazine so that if any explosives is left un-used the same can be transported
back and deposited in the magazine referred in Sr. No. 2 of above the same day before the sunset as per Rule 90(4). If so
entries should also be made online regarding the Return.

Part - B
Pass No. : RE-13/2016/4075465

Date : 11/07/2016 Time : 5:20 PM

To be filled in case explosives are left unused and to be deposited in the Magazine :
Quantity
Quantity
Quantity
Nos. of
Nos. of
Class Div. Grams Issued
Actually Unit
Batch Nos. Batch Date
Returned
Package
Cartridge
for Use
Used

S.
No.

Brand Name
(Brand ID)

Powergel Boost (Cap/Cord Sensitive)

(738)

250g

25.000

Kg.

424837033 15/06/2016

100

Powergel Boost (Cap/Cord Sensitive)

(738)

250g

25.000

Kg.

424837041 16/06/2016

100

Signature
Signature
Blaster Name : ASHIM KUMAR ROY
DGMS Certificate No.: 9841(3720)

Signature
Name of the Agent of Mine/Owner/
Authorised Person of Place of Use NARENDRA
KUMAR GUPTA

Shri Barun Banerjee (Authorized Signatory)

For M/s. Tata Steel Limited (West Bokaro Division)

(Licensee)
Licence Number
E/HQ/JH/22/328(E51574)

Licence Form
LE-3 (Old Form 22)

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